Virus-Hunting In Africa

A memoir of stalking Ebola and AIDS, surviving bureaucratic turf wars and coping with benighted public officials.

By

William Bynum

June 5, 2012 5:34 p.m. ET

Global health is big business nowadays. The sums can be enormous, but the health problems in the developing world are even larger, often seeming intractable. Health care everywhere involves stark economic and political choices, but in the developing world these may involve such basic questions as whether to build a hospital or fund community-health workers, but not both. Each constituency or group of workers sings its own song, competing fiercely for scarce donor funds.

Where do you put your money? Single-disease eradication was the traditional favorite, dating to the Rockefeller Foundation's work beginning a century ago on hookworm, schistosomiasis, sleeping sickness, malaria, yellow fever and other diseases. The World Health Organization campaign that eradicated smallpox in 1979 seemed to vindicate this single-disease, vertical approach, even as a WHO malaria program was then ending in chaos.

The malaria-eradication failure encouraged a switch to horizontal programs: supporting primary health care, health infrastructure and visits to the doctor. Such horizontal strategies were enshrined by a WHO declaration in 1978. Since then, policy pundits have argued that health money might be more efficiently spent in tangential areas, such as education (especially for women), low-tech facilities to provide clean water and electricity, and better agricultural practices, each of which can have health benefits.

But the horizontal approach remained the orthodoxy until the 1990s, when the goal posts were moved by a new disease: AIDS. After a decade in which AIDS cases in the United States, Haiti and Western Europe dominated concern, the extent of the disease's African dimensions became apparent. We now know that HIV, the virus that causes AIDS, emerged in Africa, probably as early as the 1920s, smoldering for decades until shifting economic and social circumstances ignited it into an epidemic. The gravity of its effects placed single-disease efforts back on the agenda.

Few people were better placed to appreciate the change than Peter Piot, whose fine autobiographical memoir is also an invaluable portrait of the evolution of international health in recent decades. Dr. Piot, a Flemish Belgian, was by the 1990s already an old hand in African health matters. As a young infectious-disease specialist, he was part of the first international group that in 1976 investigated another emerging virus, Ebola, the cause of a virulent disease called hemorrhagic fever because of the massive bleeding it causes.

ENLARGE

No Time to Lose

By Peter Piot (Norton, 387 pages, $28.95)

The first quarter of "No Time to Lose" describes Dr. Piot's hair-raising adventures investigating this still mysterious disease in Zaire, as the present-day Democratic Republic of the Congo was then called. Many of the Ebola cases seemed to be related to a mission hospital in Yambuku, a remote hamlet in the middle of dense rain forests. Dr. Piot and his colleagues systematically surveyed the surrounding villages for signs of the disease. They found many, gradually putting together a picture of how the virus was spread: through improperly sterilized needles used in medical injections and the close contact involved in preparing a victim for burial. Dirty needles were the key. Here Dr. Piot makes a point that he repeats later in the book: It is not enough to want to do good. The good intentions must be backed by knowledge and careful attention to best practice.

Dr. Piot once feared that he had acquired the Ebola virus and on one occasion narrowly escaped death when a helicopter he was supposed to be riding in crashed. (He helped retrieve the bodies from the middle of the jungle.) But in the end, he and his colleagues came away from Zaire with blood samples that not only aided in the identification of Ebola but also later proved valuable in investigations of the "prehistory" of AIDS.

His experience in Zaire confirmed him in his desire to focus on African health. Dr. Piot clearly loves the continent, and he extols the skills and dedication of many African doctors and health workers. In the period between working on Ebola and AIDS, he returned to Belgium to add a Ph.D. to his medical degree. He worked on sexually transmitted diseases, doing both laboratory and clinical work on gonorrhea, Chlamydia and other diseases generally spread through sexual contact. The specialty was traditionally one of low medical prestige, but Dr. Piot says that because sexually transmitted diseases were interesting scientifically and important socially—in Africa and beyond—he was unconcerned about what members of his profession might think.

His work on STDs prepared him well to study AIDS in Africa, where, he argued from the beginning, HIV could be routinely transmitted through heterosexual contact. He did important epidemiological and clinical studies in Zaire and Kenya, and he increasingly became involved with the World Health Organization and with United Nations initiatives. In 1995, when UNAIDS was created to concentrate on the disease, Dr. Piot was named executive director and remained in that position until the end of 2008.

He is wonderfully amusing, and critical, about the turf wars between international agencies and about some of the world leaders he has met. "Gambon's Omar Bongo," he says, "actually received people such as myself in a throne-like chair on a raised dais" and "wore handmade crocodile shoes with elevator heels." Nelson Mandela retains his saintly status here, but his successor, Thabo Mbeki, is judged harshly for his blinkered attitude toward AIDS: "Peter, don't you know what the real problem is?" Mr. Mbeki asked him. "Western pharmaceutical companies are trying to poison us Africans." Among Mr. Mbeki's preferred AIDS treatments: a local remedy containing garlic and carrot juice.

Because of his passion on the subject of HIV and AIDS, Dr. Piot tends to judge health executives and world leaders on how committed they have been to what he argues is the leading medical problem of our time. "No Time to Lose" is thus caustic at times, though always entertaining and thoughtful. It occasionally reads like a boy's-own adventure—but then, working on health matters around the world can present gripping and unexpected situations. We need more people like Peter Piot who will rise to the occasion with spirit and passion.

Dr. Bynum is professor emeritus of the history of medicine at University College, London.

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